Law Brings Gains for Speech-Language Pathologists and Audiologists
by Ingrida Lusis
Medicare beneficiaries and providers were affirmed resoundingly on July 15 when Congress, in a show of bipartisan support, voted to override President Bush's veto and passed H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. The House override vote was 383 to 41;the Senate vote was 70 to 26. The margins far exceeded the two-thirds vote necessary to block a presidential veto.
MIPPA reinstates the original 2008 Medicare Physician Fee Schedule (MPFS) rate retroactive to July 1 and calls for a 1.1% increase for 2009. The law also extends the therapy cap exceptions process through December 2009;recognizes speech-language pathologists as suppliers of services, allowing them to bill Medicare from private practice;and allows audiologists to participate in Medicare's Physician Quality Reporting Initiative (PQRI).
By failing to pass Medicare legislation before June 30—when short-term Medicare legislation expired—Congress allowed the scheduled 10.6% cut to take effect July 1 (see The ASHA Leader, July 15). The Centers for Medicare and Medicaid Services (CMS) began payment at the reduced MPFS rate on July 15;it has announced that it will reprocess claims retroactively to adjust the payment.
CMS immediately issued initial guidance to physicians and non-physician providers regarding fee schedule payments from July 1 to Dec. 20, and about the Medicare therapy caps exception process. Medicare contractors will continue to process claims that have been on hold on a rolling basis (first in/first out) for payment at the 10.6% reduction. After a local contractor begins to pay claims at the restored rate, the contractor will begin reprocessing claims paid at the lower rates to the extent possible.
MIPPA did not address, however, the underlying problem of the sustainable growth rate, the statutory reimbursement formula that ties fee schedule changes to an actual growth rate based on real gross domestic product per capita. Unless that issue is addressed, payment rates likely will be cut dramatically in 2010.
SLP Supplier Status
Effective July 1, 2009, SLPs will be allowed to enroll in the Medicare program and bill from a private practice. ASHA has pressed Congress for years to gain private-practice status for SLPs under Medicare, which will bring SLPs in parity with other professions. Over the next year, ASHA will work with CMS to develop and promulgate regulations to guide private-practice SLPs. The regulatory process is expected to take close to a year to finalize;ASHA will provide information to members on enrollment and other Medicare policies throughout the year.
Audiology
Eligible audiologists who report recognized quality measures under the PQRI program can receive a 2% bonus payment from Medicare. ASHA will work with CMS to develop and endorse appropriate quality measures for use by audiologists and to ensure that audiologists will be able to start reporting quality measures in 2009.
Therapy Caps
The therapy cap exceptions process allows Medicare beneficiaries with medically necessary therapy needs above current caps ($1,810 combined outpatient speech-language treatment and physical therapy, and an additional $1,810 for outpatient occupational therapy) to receive services. Although the exceptions process has been reinstated, it is a short-term solution that must be reauthorized by Congress every year. CMS recently issued a five-year contract to Research Triangle International (RTI) to develop therapy cap alternatives;ASHA is working closely with CMS and RTI on this project.
MIPPA reinstated the exceptions process as of July 1. Claims submitted with the therapy cap exception modifier will be processed as soon as the payment rates have been activated. Claims submitted without the modifier, and rejected or denied, can be resubmitted with the modifier for reimbursement. To the extent possible, claims under the therapy cap limit paid at the lower rate will be reprocessed automatically. More information about therapy caps is available on the HHS Web site.
MIPPA pays for the postponed decrease in the MPFS through reductions in reimbursements to insurance companies that serve Medicare beneficiaries under Medicare Advantage, the managed care program of private fee-for-service-plans. The White House had opposed the legislation over funding concerns.
